Acute stress disorder (ASD) is characterized by a
constellation of symptoms that occur in the acute aftermath of a trauma, such as
the rape experienced by this young woman. A traumatic event is described in
the DSM-IV-TR as one in which "the person experienced, witnessed,
or was confronted with an event or events that involved actual or threatened death
or serious injury, or a threat to the physical integrity of self or others."1
The patients response to the traumatic event involves "intense fear,
helplessness, or horror." Following the traumatic event, patients typically
experience symptoms of dissociation (eg, numbing, detachment, or absent emotional
responsiveness), persistent re-experiencing of the trauma (eg, flashbacks, nightmares),
avoidance of stimuli that arouse recollections of the trauma, and marked symptoms
of anxiety and hyperarousal. ASD can occur at any time, up to a month following the
traumatic event. After a month, patients who experience these symptoms are diagnosed
as having posttraumatic stress disorder (PTSD).
One might be tempted to diagnose her with adjustment
disorder, but the stress of a rape is one that is considered extreme. The adjustment
disorder diagnosis could be assigned if she had the same symptoms from a lesser
stress, such as losing a job, or if the rape evoked distressing symptoms but not
ones of sufficient severity to meet the criteria for ASD.
This patient is at high risk for developing a depressive
episode but does not meet the criteria of major depression at this time, since
her symptoms began only 10 days ago. Approximately 50% of patients with PTSD will
develop major depression.